Effects of acupuncture on quality of life and pain in patients with osteoporosis-a pilot randomized controlled trial

Pain Management in Osteoporosis

The most prevalent metabolic bone disease, osteoporosis, is characterized by a decrease in bone mineral density and alterations to the bone's microstructure, both of which can result in fragility fractures. It affects a significant section of the population. Acute or chronic pain from these fractures is typical in elderly adults with other coexisting conditions. Since the antiresorptive medication only partially reduces pain, other analgesics are required for effective pain management. NSAIDs or selective COX-2 inhibitors can reduce acute pain, but persistent neuropathic pain is difficult to manage with these drugs. Opioids have their adverse effects and safety concerns, although they can be used to address acute or chronic pain. Hence, a multifaceted approach is to be implemented, including pharmacological and nonpharmacological therapy and surgical treatment in a selected number of cases. This chapter briefly describes the etiology of pain, its mechanism, and pain management in osteoporotic patients.

Effect of laser acupuncture on pain and density of bone in osteoporotic postmenopausal women: a randomized controlled trial

OBJECTIVE

This study aimed to evaluate the value of laser acupuncture (LA) on forearm bone mineral density (BMD) and wrist pain in osteoporotic postmenopausal women.

METHODS

Sixty-eight postmenopausal women diagnosed with osteoporosis were randomly allocated equally to one of two sets. The drug-only group received calcium and vitamin D 3 supplement containing fluoride daily for 12 weeks, whereas the drug/LA group received LA therapy for 20 minutes per session, three sessions weekly, in addition to the same supplementation. The primary outcome parameter was assessment of BMD of the nondominant arm. Other outcomes included wrist pain.

RESULTS

There was a highly significant improvement in the T-score of forearm BMD in both groups (-2.844 ± 0.476 to -2.597 ± 0.478 and -2.944 ± 0.486 to -1.652 ± 0.728 in the drug-only and drug/LA groups, respectively; P < 0.0001) and visual analog scale score (7.50 ± 0.79 to 4.24 ± 1.07 and 7.24 ± 0.82 to 3.09 ± 0.75 in the drug-only and drug/LA group, respectively; P < 0.0001). The improvement of both BMD and pain score was significantly higher in the drug/LA group (-1.303 and 4.15) compared with the drug-only group (-0.247 and 3.26; P < 0.0001).

CONCLUSIONS

LA in combination with calcium and vitamin D supplementation containing fluoride is an effective modality in improving forearm BMD and reducing pain in osteoporotic postmenopausal women.

Acupuncture as Part of Multimodal Analgesia for Chronic Pain

Background

Chronic pain is a multifactorial condition that is afflicting populations worldwide causing an increasing economic, physical, mental, and emotional burden. Treatments range from medications to interventional procedures to complementary and alternative medicine (CAM), such as acupuncture. This review aims to discuss the use of acupuncture in the treatment of chronic pain, proposed mechanisms, indications, and efficacy for various chronic pain conditions.

Results

Evidence is varied on the efficacy and quality of data on the use of acupuncture in the treatment of chronic pain. Recent studies have demonstrated promising results in the support of acupuncture for the use in the treatment of cancer, neck, and back pain, functional dyspepsia, and various chronic abdominal pain syndromes.

Conclusion

Acupuncture, deemed well-tolerated and safe to use, has been increasingly studied and is regarded as effective in clinical practice, but its efficacy is limited by the lack of well-conducted, high-quality clinical trials, lower quality evidence, and conflicting study results. Additionally, the exact analgesic mechanism of acupuncture remains to be fully elucidated. Increasing evidence supports the role of acupuncture as therapy in the treatment of cancer, neck, and back pain and functional dyspepsia. Further rigorous studies are needed to fully assess the use of acupuncture in various chronic pain conditions, determine its indications, and optimal treatment schedule. Overall, future studies could benefit from better designed experimental studies, larger groups, and more objectives ways to measure pain reduction and symptom improvement.

Evaluating the Characteristics, Reporting and Methodological Quality of Systematic Reviews of Acupuncture for Low Back Pain by Using the Veritas Plot

Objective

To evaluate systematic reviews (SRs) of acupuncture for low back pain (LBP) in terms of characteristics, reporting and methodological quality using a Veritas plot and to explore factors that may be associated with methodological quality and reporting quality.

Study Design and Setting

We searched 8 electronic bibliographic databases to find all SRs, and we evaluated the SRs' quality in 6 dimensions, including publication year, design type, homogeneity, risk of publication bias, methodological quality by Assessment of Multiple Systematic Reviews (AMSTAR) 2 and reporting quality by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Excel 2010 and Adobe Illustrator CC were used to draw and optimize Veritas plots. Exploratory analysis was done using SPSS software version 23.0 to explore factors related to AMSTAR-2 and PRISMA scores. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence quality evaluation tool was used to grade all the outcome indicators in the included literature.

Results

We included 19 SRs in the analysis. Literature quality rank scores ranged from 9.67 to 17.00, with an average score of 13.18 ± 2.35. The average score of AMSTAR-2 was 7.47, and the average score of PRISMA was 18.47. Overall, the main issues were research strategies, inclusion and exclusion criteria, publication bias, and registration in PROSPERO. The results of exploratory analysis showed that duplication of literature selected and appropriate tools to assess the risk of bias were related to the AMSTAR-2 score, and the summary of evidence was related to the PRISMA score. The GRADE quality evaluation results showed mainly low quality.

Conclusion

The quality of SRs on acupuncture for low back pain should be improved, mainly by strengthening the methodological quality and reporting quality. The Veritas plot is an effective graphical evaluation method that is worth popularizing.

Acupuncture for Primary Osteoporosis: Evidence, Potential Treatment Prescriptions, and Mechanisms

Many clinical trials and meta-analyses related to acupuncture for osteoporosis (OP) have been published. However, identifying the evidence from these studies still remains a challenge for acupuncturists. We conducted a systematic search of the Chinese Biomedical Medicine (CBM), VIP Database, Wanfang Data, China National Knowledge Infrastructure (CNKI), PubMed, Springer, Cochrane Library, and Embase to identify relevant trials, systematic reviews, and/or meta-analyses up to October 31, 2018. Data were extracted to assess the methodological quality using Veritas plots and to explore potential acupuncture prescriptions using the Traditional Chinese Medicine inheritance support system (TCMISS). In addition, potential mechanisms of core acupoints identified by data mining were summarized based on published studies. A total of 218 clinical trials and ten meta-analyses were included, involving 212 acupuncture prescriptions, 102 acupoints, 13 meridians, three extra meridians, and one Ashi point. The mean Veritas score of publication year, type of study, Assessment of Multiple Systematic Reviews 2, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, heterogeneity, and publication bias were 5.5, 7.2, 6, 5.6, 5.8, and 7.5, respectively. The study of Pan et al. received the highest Veritas score of 8.67 points. The most frequently used meridian was BL. Acupoint combinations BL23 and BL20, BL23 and GV4, and BL23 and ST36 were used frequently. The core acupoints association networks were acupoints BL23, BL20, ST36, GV4, SP6, CV4, and KI3. The potential mechanisms of core acupoints involved upregulated expression of members in OPG/RANKL, Wnt/β-catenin, and MAPK pathways, such as LRP5, β-catenin, Runx2, and OPG. In conclusion, our Veritas plots enable acupuncturists to evaluate key attributes of meta-analysis quality related to acupuncture for primary OP and to improve the quality of evidence-based medicine relating to acupuncture. Data mining analysis revealed an association network of meridians, acupoint combinations, core acupoints, and the underlying mechanisms of acupuncture for primary OP.

Pain in Osteoporosis: From Pathophysiology to Therapeutic Approach

The high worldwide prevalence of osteoporosis means it is considered a serious public health concern, possibly leading to physical disability and an increased mortality rate. Although osteoporosis is known as a silent disease affecting aging populations, its primary symptom remains pain. Acute pain is reported by patients with osteoporosis-related fractures, but chronic pain, mainly back pain, is also a characteristic of severe osteoporosis. Pain is associated not only with fractures but also with bodily changes in patients with osteoporosis that may include sensory, affective, and cognitive aspects. Chronic pain leads to progressive loss of independence and the need for long-term care, especially in the elderly. Pain prevention is linked to the appropriate treatment of osteoporosis, and pain management in patients with osteoporosis requires a multidimensional approach to preserve and improve quality of life. Our aim was to review and discuss the main causes of pain in patients with osteoporosis and suggest possible strategies for its management and prevention.